The Quick Guide to Testosterone Replacement Therapy (TRT) – Benefits, Risks, and What to Expect
- mettawellnessnw
- Apr 4
- 5 min read
What is Testosterone Replacement Therapy?
Testosterone Replacement Therapy (TRT) is a treatment designed to address symptoms of low testosterone, also known as hypogonadism. Testosterone is a critical hormone responsible for various functions, including muscle growth, bone density, mood regulation, and sexual function. As men age, testosterone levels can decrease, leading to symptoms such as fatigue, low libido, depression, and reduced muscle mass. TRT aims to restore testosterone levels to a normal range, improving overall well-being and quality of life. Testosterone levels in men decline 1% annually after age 30. Some studies indicate upwards of 2%.
Benefits of Testosterone Replacement Therapy
TRT offers several documented benefits for men with hypogonadism. According to the American Urological Association (AUA), TRT can significantly improve sexual function, including erectile function and libido, which are often primary concerns for men with low testosterone. Additionally, TRT has been shown to enhance mood and energy levels, potentially alleviating depressive symptoms and fatigue.
Additional benefits of TRT include:
Improved Muscle Mass and Strength: TRT contributes to increased muscle mass and strength, which can enhance physical performance and reduce the risk of falls and fractures.
Enhanced Bone Density: Improved bone density through TRT can reduce the risk of osteoporosis and related fractures, particularly in older men.
Mood and Cognitive Function: Many men report improved mood, reduced anxiety, and better cognitive clarity with TRT, although results can vary depending on individual health factors.
Metabolic Health: TRT may assist in reducing body fat and improving metabolic parameters such as insulin sensitivity, though more research is needed in this area.
That sounds pretty good.
What are the Risks of Testosterone Replacement Therapy?
While TRT can be beneficial, it is associated with several potential risks. It is essential for patients to be informed about these risks before starting treatment.
Erythrocytosis: TRT can increase the risk of erythrocytosis, a condition where the body produces too many red blood cells. This can elevate hematocrit levels, which may increase the risk of blood clots or stroke. This often stabilizes after a year
Prostate Concerns: TRT can lead to elevated prostate-specific antigen (PSA) levels, which may complicate the diagnosis and management of prostate conditions.
Fertility Reduction: TRT can suppress natural testosterone production and sperm production, potentially affecting fertility. Men wishing to maintain fertility on TRT can take other medications to maintain fertility if this is a concern. Similarly, yes your nuts may shrink, but this can be minimized.
Other Risks: Potential side effects include fluid retention, acne, breast tenderness, and mood changes.
Can testosterone affect the heart?
In February 2025, the U.S. Food and Drug Administration (FDA) updated the labeling for all testosterone products. This update removed the previous boxed warning about an increased risk of adverse cardiovascular events, such as heart attacks and strokes. The change was based on findings from the TRAVERSE clinical trial, which concluded that testosterone replacement therapy (TRT) does not increase cardiovascular risk in men with hypogonadism. Nice!
The FDA has added a new warning regarding increased blood pressure associated with TRT use. Regular monitoring of blood pressure is recommended for individuals undergoing TRT to manage this potential risk.
What to Expect from TRT
Before starting TRT, patients should undergo a thorough evaluation to confirm hypogonadism. This typically includes two morning serum testosterone measurements taken on separate days. A comprehensive assessment also includes a medical history review, and additional blood tests to assess overall health and hormone levels.
Regular labs are drawn as your dosage is increased over a year or so. Often it takes 3-6 months to see and feel the full benefit and while dosage changes are made, so don't be discouraged.
Treatment Options:
Intramuscular Injections: Commonly administered every one to two weeks (eek). Typically at least twice weekly dosing is most effective. They are often preferred for their cost-effectiveness and ability to deliver higher testosterone levels.
Transdermal Cream or Gels: Applied daily to the skin (nuts). This option provides a consistent delivery of testosterone and may cause skin irritation in some individuals.
Subcutaneous Injections: Increasingly popular due to convenience and potentially fewer side effects. Similar to intramuscular.
Implantable Pellets: Inserted under the skin and provide a release of testosterone over several months. The issue is they level raises over time, peaks, then declines, thus there is no steady state.
Nasal Spray: If you really want to avoid all other options, you can do a nasal spray. Cost can be a factor and the frequency of dosing (3x/day)
Oral Troche: Like the nasal spray you'll be doing this three times a day waiting for a tab to dissolve, but for some guys this works well.
Monitoring and Follow-Up:
Regular monitoring of testosterone levels, hematocrit, PSA, and estradiol levels is essential.
Follow-up visits to assess symptom improvement and adjust dosages if necessary.
Long-term monitoring to minimize risks and ensure continued benefits.
Shared Decision-Making: Patients and providers should collaborate to determine the most appropriate TRT plan based on individual needs, symptoms, and health status. Understanding the benefits, risks, and expectations associated with TRT is essential for making an informed decision.
Should You Take Testosterone?
Testosterone Replacement Therapy can offer significant benefits for men with low testosterone, improving energy, mood, muscle mass, and overall well-being. As with any therapy, it is essential to understand the potential risks and maintain ongoing monitoring to ensure safety and effectiveness. Patients should discuss their symptoms, goals, and concerns with their healthcare provider to determine whether TRT is the way to go.
Ultimately, if you are a man that is down in the dumps mentally, physically, and all around feeling a lack of motivation, TRT may be the kickstart you need. There is more than just testosterone needed for full vitality, but it will help you get there.
References
American Urological Association. (2020). Testosterone Therapy in Men with Hypogonadism: An AUA Clinical Practice Guideline. The Journal of Urology.
FDA. (2015). Testosterone and Other Anabolic Androgenic Steroids (AAS): Risks Associated with Abuse and Dependence.
Bassil N., Alkaade S., Morley J.E. (2009). The benefits and risks of testosterone replacement therapy: a review. Therapeutics and Clinical Risk Management.
American College of Physicians. (2020). Testosterone Treatment in Adult Men with Age-Related Low Testosterone: A Clinical Guideline From the American College of Physicians. Annals of Internal Medicine.
Disclaimer:
The information provided in this blog post is for informational purposes only and is not intended as medical advice. It is not a substitute for professional medical evaluation, diagnosis, or treatment. Always consult your healthcare provider before starting or modifying any treatment plan, including Testosterone Replacement Therapy (TRT). Metta Wellness NW’s providers follow evidence-based practices to ensure patient safety and well-being.
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